Introduction

Encore’s eMeasure Research and Review Board (eMRB) provides direction and common perspective on how eMeasures are applied in a value-based reimbursement environment. To help keep others informed and share our knowledge, eMRB provides this high level monthly recap summarizing everything eMeasure-relevant that happened in February.

As you read through this February recap, you will notice a theme on physician quality programs. This is due to the influence of the MACRA legislation and the focus on aligning quality and value-based programs. You’ll read about two proposed rules, one on the Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) and one on Qualified Entities; you will be updated on status of the Improving Health Information Technology Act; and you will read all about the new sets of core quality measures jointly announced by CMS and America’s Health Insurance Plans (AHIP) and their tie to the Draft Quality Measure Development Plan. Under Information Sources, you’ll find eMRB’s question of the month, which keeps with the physician quality reporting theme, and a description of the new CMS FAQs recently published forthe EHR Incentive programs. Under Announcements and Events we highlight Dana Sellers (Encore’s CEO) interview on “EHR, What’s Next?”; and identify key messages from two recent CMS webinars covering hospital and physician quality reporting for 2016.

Proposed rule covering process for resetting ACO benchmarks and moving towards a focus of regional cost trends rather than national.

It also proposes to add a participation option allowing eligible ACOs to elect a fourth year under their existing first agreement and defer by one year entering a second agreement period under a performance-based risk track.

If eligible professionals (EPs) participating in an ACO meet requirements of a qualified APM, they could receive a 5 percent payment bonus for up to 6 years beginning in January 2019.

Parameters of what constitutes a qualifying APM are yet to be published; we expect to see more details in the upcoming Merit-based Incentive Payment System (MIPS) and APM proposed rule anticipated in the March timeframe.

Relevant to MSSP ACOs, the MACRA legislation provided the criteria that entities participating in an APM bear financial risk for monetary losses that are in excess of nominal amount. The question we are looking to see answered in the pending proposed rule is whether or not an ACO that is not yet participating in a performance-based risk track will be considered as a qualifying APM.

Another MACRA driven proposed rule that would allow organizations that are approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care.

Why does it matter?

The ability to purchase the data can support providers in developing and testing measures in a “sandbox” before implementing the measures. The data can also be used to provide insights of where to improve patient care outcomes.

This bill has been Introduced (first step); Reported by Committee (second step) and on February 9th it was sent to the full chamber (House and Senate) with recommendation that the bill be considered further.

Biggest impact of this bill will be understanding any changes to certified electronic health record (EHR) and health information exchange (HIE) requirements related to value-based regulatory programs such as Meaningful Use (MU), MIPS, APMs, and Hospital Value-Based Purchasing (VBP).

The Core Quality Measures Collaborative released a set of seven core measures to be used as basis for quality-based payments.

The core sets support multi-payer alignment primarily for physician quality programs. Of note, this was done for hospitals with the creation of core measures that aligned the Inpatient Quality Reporting (IQR) program and The Joint Commission (TJC) measures.

One measure set covers ACOs, patient centered medical homes (PCMH), and Primary Care; the other six are specialty and disease specific.

This work is informing CMS’ implementation of the MACRA legislation through its Quality Measure Development Plan (MDP) and CMS will solicit input on the agreed upon measure sets for public comment in future proposed rules.

Private payers will use a phased-in approach to implementing the measures as they renew contracts or if existing contracts allow modification of the performance measures.

Several of the measures included in the core set require clinical data extracted from EHRs, are self-reported by providers, or rely on registries.

The infrastructure to collect data on all the measures in the core set does not currently exist; providers and payers will need to work together to create a reporting infrastructure for the measures.

Authorized by the MACRA legislation, CMS has developed a draft Quality Measure Development Plan, which was informed by the development of the above mentioned core measure sets and identification of key measure gaps.

The MDP will support MIPS as well as other APMs such as ACOs.

There is ongoing focus for creating eMeasures, but data sources are also expanded to include qualified clinical data registries (QCDRs); in addition to EHRs.

The draft plan was published on December 18, 2015 for comment; comments close on March 1, 2016 and the final plan will be posted by May 1, 2016.

Implications of the Core Measures and the MDP

Focus is on physician payment models and is relevant for new payment models outside the hospital including ACOs and population health initiatives.

Changes could impact hospitals’ employed and affiliated physicians where they provide IT and quality reporting services.

The MDP brings additional data sources (registries) into the discussion, which is relevant to provider associations such as the American Heart Association’s Get With The Guidelines Program or American College of Surgeons.

Information Sources

eMeasure Research and Review Board’s Questions of the month are…

Question 1: Is there a requirement for EPs to participate in the Physician Quality Reporting System (PQRS) program?

eMRB’s Answer: PQRS is a voluntary program to promote reporting of quality information by EPs and group practices. All EPs who do not meet the criteria for satisfactory reporting or participating in PQRS will be subject to the negative payment adjustment.

Question 2: Does PQRS require electronic submission for eCQMs?

eMRB’s Answer:No. PQRS includes multiple reporting options, each with different submission requirements. Electronic submission is one option.

Question 3: Does Meaningful Use for EPs require electronic submission of eCQMs?

eMRB’s Answer: Guidance from the EHR Incentive Programs 2015 through 2017 (Modified Stage 2) Overview Fact Sheet states that for 2016 and subsequent years, providers attest to one full calendar year of CQM data or electronically report CQM data using established electronic reporting methods.

Impact: No documentation needs to be submitted with the hardship exception application; providers should retain documentation of their circumstances for their own records, but no such documentation is required for review by CMS. See FAQ for full details.

2) 2/1/2016, updated FAQ12845 – Covers hardship exceptions due to timing of the EHR Incentive Program Stage 3 and Modifications to Meaningful Use in 2015 through 2017 final rule.

Impact: No documentation needs to be submitted with the hardship exception application for this or any other hardship category selected. Providers should retain documentation of their circumstances for their own records, but no such documentation is required for review by CMS. See FAQ for full details.

Impact: Hospital-based EPs do not qualify for Medicare or Medicaid EHR incentive payments. A hospital-based EP is defined as an EP who furnishes 90% or more of their services in either inpatient or the Emergency Department of a hospital. See FAQ for full details.

Update, 2/22/2016: CMS provided an update on the phone number that was posted for this FAQ. The update is: If you are a new EP and need to determine your hospital-based status, contact the EHR information center at (888) 734-6433. Choose option 1 for the EHR Incentive Programs, then choose option 4 in the interactive voice response system (IVR).

4) 2/25/2016, new FAQ14393 – Covers when providers can register their intent to report to a registry.

Impact: If a registry declares readiness at any point in the calendar year after the initial 60 days, a provider may still register their intent to report with that registry to meet the measure under Active Engagement Option 1. See FAQ for full details.

5) 2/25/2016, new FAQ14397 – Provides guidance for what a provider should do in 2016 if they did not previously intend to report to a public health reporting measure.

Impact: CMS will allow providers to claim an alternate exclusion from certain public health reporting measures in 2016 if they did not previously intend to report to the Stage 2 menu measure. EPs are allowed to claim an alternate exclusion for Public Health Reporting measure 2 – syndromic surveillance; and both EPs and eligible hospitals (EHs) are allowed to claim an alternate exclusion for Public Health Reporting measure 3 – specialized registry. See FAQ for full details.

6) 2/25/2016, new FAQ14401 – Covers alternate exclusions that can apply when required technology is not available for public health reporting in 2016.

Impact: CMS will allow providers to claim an alternate exclusion for the Public Health Reporting measure(s) which might require the acquisition of additional technologies providers did not previously have or did not previously intend to include in their activities for meaningful use. An Alternate Exclusion may only be claimed for — EPs two measures, and EHs one measure — then the provider must either attest to or meet the exclusion requirements for the remaining measures. See FAQ for full details.

7) 2/25/2016, updated FAQ13657 – Identifies steps for providers to take to determine if there is a specialized registry available for them.

Impact: This FAQ provides updated guidance for EPs. An EP is not required to make an exhaustive search of all potential registries, but they must do a few steps to meet due diligence in determining if there is a registry available for them, or if they meet the exclusion criteria. See FAQ for full details.

Impact: This FAQ provides updated guidance for EHs or CAHs; they do not need to explore every specialty society with which their hospital-based specialists may be affiliated. The hospital needs to check with their State* and any such organization with which it is affiliated, and if no registries exist, they may exclude from the measure. See FAQ for full details.

9) 2/25/2016, updated FAQ13653 – States what counts as a specialized registry.

Impact: A submission to a specialized registry may count if the receiving entity declares they are ready to accept data as a specialized registry and using the data to improve population health outcomes; if they are able to receive electronic data generated from certified EHR technology (CEHRT); and if they have a registration of intent process, a process to take the provider through test and validation, and a process to move into production. For qualified clinical data registries (QCDR), reporting to a QCDR may count for the public health specialized registry measure if the registry is also using the data for a public health purpose. See FAQ for full details.

10) 2/26/2016, updated FAQ14357– States that submission of a hardship exception application does not prevent a provider from attesting and receiving an incentive payment if MU requirements are met.

Impact: CMS encourages providers to attest to MU by March 11, 2016. Deadline to submit a hardship exception application for both EPs and EHs is July 1, 2016. See FAQ for full details.

Announcements and Events

It’s not too late to catch the replay of the February 4th video chat interview with Dana Sellers, CEO of Encore, and John Lynn, Founder of HealthcareScene.com.

Key messages: Electronic submission of eCQMs is not yet required for EH Meaningful Use; hospitals can still satisfy the CQM requirement by aggregate reporting of 16 eCQMs for a full year through the CMS Registration and Attestation System. If a hospital reports 4 eCQMs through QualityNet for one quarter (Q3 or Q4) of CY 2016, it satisfies the eCQM requirement for MU as well as the IQR program.

Key messages: Electronic submission of eCQMs is also not required for the PQRS program; there are multiple Reporting Options, all with different submission requirements. Electronic submission is one option. The new MIPS program authorized by MACRA begins on January 1, 2019. EPs can participate in MIPS or meet requirements to be a qualifying APM participant. MIPS will consolidate the separate application of payment adjustments under the PQRS, Value-based Modifier (VM), and the EHR Incentive (MU) programs. Under MIPS, providers can receive a positive, negative or zero payment adjustment; and if an APM participant, providers can receive a 5 percent incentive payment for 6 years.

To read previous versions of the eMeasures News You Can Use, you can locate them on Encore’s Website under the Press Room.

Points of view and interpretation were relevant at time of authorship; however, they are subject to change over time.

eMRB
Encore’s eMeasure Research and Review Board is made up of Encore’s industry thought leaders and eMeasure experts who are responsible for understanding the current state and future direction of quality and value-based programs for Encore’s business.

Questions/Comments

Points of view and interpretation were relevant at time of authorship; however, they are subject to change over time.

Encore’s eMeasure Research and Review Board (eMRB) is made up of Encore’s industry thought leaders and eMeasure experts who are responsible for understanding the current state and future direction of quality and value-based programs for our business. In order to communicate relevant information to our consultants and our clients, eMRB produces periodic InfoAlerts, which provide information on recent and important news.